Consent to Criminal Record Check~1.docx

COMMONWEALTH OF MASSACHUSETTS

THE TRIAL COURT

Consent to Criminal Record Check for Per Diem Court Reporter

CONSENT TO CRIMINAL RECORD CHECK

Section I. To be completed by the Vendor/Vendor Firm.

I understand that in order to be a Vendor/Vendor Firm for the Massachusetts Trial Court, I must submit to a Criminal Record Check. Therefore, I provide my consent to a criminal record check and acknowledge that the information provided below is true and accurate.

Full Name: _____________________________________________________________ (First) (Middle) (Last)

Date of Birth: _______________ Social Security Number: ______________________

Maiden Name or other name(s) by which you have been known: ________________

Mother’s Maiden Name: _________________________________________________

Father’s Full Name: _____________________________________________________ (First) (Middle) (Last)

Signature: _________________________________ Date: _______________________

Section II. To be completed by the Office of the Commissioner of Probation.

_____ Record check does comply with Personnel Policies and Procedures Manual.

_____ Record check does not comply with Personnel Policies and Procedures Manual.

Signature: ___________________________________ Date: _____________________